TemplatesOwl
Homepage ↦ Fill Out Your Class Action Claim Form
Article Structure

The Class Action Claim form is a critical document for individuals seeking compensation from the Edna Mahan Correctional Facility for Women class action settlement. This form fulfills several essential functions, ensuring that claimants provide relevant personal information such as their name, contact details, and incarceration history at the facility since January 1, 2014. It also includes tier selection, allowing individuals to indicate which level of compensation they believe they qualify for. Claimants have three tiers from which to choose, each with varying compensation amounts and stipulations. Higher tiers require additional documentation and may include the necessity of a hearing, particularly for severe cases of sexual abuse. Claimants may also request assistance from law students to navigate the claims process effectively. Completing this form accurately is crucial, as failures to return it by the set deadline can result in loss of compensation while still binding individuals to the settlement. Detailed instructions and a checklist help ensure that all necessary information and documents are submitted promptly.

Class Action Claim Example

EMCFW Settlement Administrator c/o Postlethwaite & Netterville P.O. Box 3595

Baton Rouge, LA 70821

Your Claim Form Must Be

Completed and Postmarked On or

Before October 29, 2021

EDNA MAHAN CORRECTIONAL FACILITY FOR WOMEN CLASS ACTION SETTLEMENT

Superior Court of New Jersey, Hunterdon County

CLAIM FORM

FAILURE TO COMPLETE AND RETURN THIS CLAIM FORM BY THE ABOVE DATE WILL RESULT IN A FORFEITURE OF ANY

COMPENSATION AND WILL STILL BIND YOU TO THE SETTLEMENT AND RELEASE.

I. Personal Information

(

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

First Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Middle Name

 

 

 

 

 

 

 

 

 

 

 

 

 

Last

 

Name

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Suffix

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name While

 

at Edna

 

Mahan

 

Correctional

 

Facility

 

(If

 

Different)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

/

 

 

 

 

 

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date

 

of

 

Birth

 

 

 

 

 

 

 

 

‐

 

 

 

 

 

 

 

 

 

 

 

 

 

Last Four Digits

 

of SSN

 

 

 

 

SBI

Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone

 

Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E-Mail

 

Address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mailing

 

Address:

 

Street

 

Address/P.O.

 

Box

 

(include

 

 

 

Apartment/Suite/Floor

 

 

 

Number)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

State

 

 

 

Zip

 

Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Preferred Method of Communication:

 

 

 

 

 

Mail

 

 

 

 

 

E-Mail

 

 

Phone

 

 

Months (to be verified by NJDOC)

 

Months Incarcerated at Edna Mahan Correctional

Facility since

January 1,

 

2014:

 

 

 

 

 

 

 

 

 

II. Tier Selection

Please check the box to indicate which tiered settlement you are claiming and whether you are requesting a hearing (where

applicable). For a complete description of each tier and definition of terms, please refer to the legal notice.

TIER 1

Compensation of $1,000 plus $20 per month (or partial month) incarcerated at Edna Mahan Correctional

 

Facility since January 1, 2014. Selection of this tier does not require any additional documentation, with

 

payment expected by January 27, 2022.

TIER 2

TIER 3

Compensation of up to $4,500 for victims who experienced sexual harassment while incarcerated at Edna Mahan Correctional Facility. Selection of this tier requires a separate affidavit or certification describing the sexual harassment you claim you experienced. Claimants selecting this tier also have the option of submitting contemporaneous corroborating documentation with their claim and requesting a hearing. Payment will be made for claimants in this tier after all Tier 2 and Tier 3 claims have been heard and decided. If no selection is made below, no hearing will be requested.

YES, I would like to request a hearing for my claim

NO, I do not request a hearing for my claim

Compensation of up to $250,000 for victims who experienced sexual abuse while incarcerated at Edna Mahan Correctional Facility. Selection of this tier requires a separate affidavit or certification describing the sexual abuse you claim you experienced plus contemporaneous corroborating documentation. A hearing is mandatory for Tier 3 claims. Payments will be made for claimants in this tier after all Tier 2 and Tier 3 claims have been heard and decided.

EDNA MAHAN CORRECTIONAL FACILITY FOR WOMEN CLASS ACTION SETTLEMENT

Superior Court of New Jersey, Hunterdon County

III. Pro Bono Assistance

For Tier 2 claimants who are requesting a hearing, and Tier 3 claimants who are required to have a hearing, please indicate whether you are interested in receiving assistance from representatives of a New Jersey-based law school clinic in preparing your certification and/or affidavit, collecting supporting documentation, and preparing for your hearing.

YES, I would like assistance. Please have a clinic contact me.

NO, I would not like assistance.

IV. Certification

I certify that the above is true and correct to the best of my knowledge. I understand that if any of the foregoing is willfully false, I am

subject to punishment.

Date

Signature

Printed Name

Reminder Checklist

1.Complete all sections of this Claim Form.

2.Sign and date the Claim Form in Section IV.

3.Keep copies of the completed Claim Form and documentation for your own records.

4.Mail your completed Claim Form to the Settlement Administrator at the address at the top of Page 1 of this Claim Form.

5.It is your responsibility to notify the Settlement Administrator of any changes to your contact information after the submission of your Claim Form. You can contact the Settlement Administrator at 1-844-810-1507 or by email at info@EMCFWsettlement.com

6.Please visit the settlement website at www.EMCFWsettlement.com for more information about this settlement.

Get Class Action Claim PDF Form

Form Characteristics

Fact Title Details
Claim Submission Deadline Your claim form must be postmarked on or before October 29, 2021.
Location for Submission Send completed claim forms to EMCFW Settlement Administrator, c/o Postlethwaite & Netterville, P.O. Box 3595, Baton Rouge, LA 70821.
Governing Authority The claims are administered under the jurisdiction of the Superior Court of New Jersey, Hunterdon County.
Binding Nature of Settlement Failure to complete and return the form by the deadline results in forfeiture of compensation yet binding to the settlement.
Personal Information Required Claimants must provide personal information including name, date of birth, and last four digits of Social Security Number.
Tier Selection There are three tiers of compensation available, with varying requirements and amounts based on the nature of claims.
Pro Bono Assistance Availability Claimants requesting a hearing can receive assistance from a New Jersey-based law school clinic.
Mandatory Hearings For Tier 3 claims, a hearing is mandatory to evaluate the submitted documentation and claims.
Eligibility for Compensation Compensation amounts vary: Tier 1 offers $1,000, Tier 2 offers up to $4,500 for sexual harassment, and Tier 3 offers up to $250,000 for sexual abuse.
Documentation Requirements Tiers 2 and 3 require additional affidavits or documentation, which must accompany the claim form for these claims to be valid.

Guidelines on Utilizing Class Action Claim

Once your Class Action Claim form is completed, it's essential to ensure that you follow the necessary steps to submit it successfully. Adhering to the guidelines provided can help you secure your rightful compensation. Make sure to pay attention to the details as this will be crucial in avoiding any issues with your submission.

  1. Begin by filling out your personal information accurately in Section I. This includes your first name, middle name, last name, suffix, date of birth, and other required details.
  2. Provide your contact information, including your phone number, email address, and mailing address. Ensure that all information is current to receive any correspondence related to your claim.
  3. Indicate your preferred method of communication—whether by mail, email, or phone.
  4. In Section II, select the appropriate tier for your claim by checking the corresponding box. Ensure you understand the requirements for each tier, including the need for additional documentation if applicable.
  5. If you are applying for Tier 2 or Tier 3, be sure to prepare the necessary affidavit or certification and any corroborating documentation. For Tier 3, a hearing will be mandatory.
  6. In Section III, indicate whether you would like to receive assistance from a New Jersey-based law school clinic if you're submitting a Tier 2 or Tier 3 claim.
  7. Before submitting, review everything you have completed to confirm accuracy. Fill in the date, sign your name, and print it clearly in Section IV.
  8. Make copies of the completed Claim Form and any documentation for your records.
  9. Mail your completed Claim Form to the Settlement Administrator at the specified address to ensure it is received by the deadline. Remember, it must be postmarked on or before October 29, 2021.
  10. After submission, if any changes to your contact information occur, promptly notify the Settlement Administrator using the provided contact information.

For further information about the settlement, visiting the settlement website can provide valuable resources and answers to common questions that claimants may have.

What You Should Know About This Form

What is the Class Action Claim Form?

The Class Action Claim Form is a document used by individuals who wish to participate in the Edna Mahan Correctional Facility for Women Class Action Settlement. It allows eligible claimants to request compensation based on their experiences while incarcerated at the facility.

How do I submit my Claim Form?

You should complete all sections of the Claim Form and mail it to the Settlement Administrator at EMCFW Settlement Administrator, c/o Postlethwaite & Netterville, P.O. Box 3595, Baton Rouge, LA 70821. Ensure that your Claim Form is postmarked on or before October 29, 2021.

What happens if I do not submit the Claim Form by the deadline?

If you do not complete and return the Claim Form by the deadline, you will forfeit any potential compensation. However, you will still be bound by the terms of the settlement and release.

What information will I need to provide in the Claim Form?

You will need to provide personal information such as your name, date of birth, phone number, email address, and mailing address. Additionally, you should indicate your months incarcerated at the Edna Mahan Correctional Facility and select a tier for compensation.

What are the different tiers of compensation?

There are three tiers of compensation. Tier 1 offers $1,000 plus $20 for each month incarcerated since January 1, 2014. Tier 2 provides compensation of up to $4,500 for those who experienced sexual harassment while incarcerated. Tier 3 offers up to $250,000 for victims of sexual abuse. Specific documents are required for Tier 2 and Tier 3 claims.

Can I request a hearing for my claim?

Yes, you may request a hearing for your claim if you select Tier 2 or Tier 3. Indicate your choice on the form. For Tier 3, a hearing is mandatory.

What if I need help with my Claim Form?

If you are a Tier 2 claimant requesting a hearing or a Tier 3 claimant, you can request assistance from representatives of a New Jersey-based law school clinic. Indicate your interest in receiving assistance in the Claim Form.

What should I do after I submit my claim?

After submitting your claim, it is essential to keep copies for your records. You should also notify the Settlement Administrator of any changes to your contact information. You can reach them at 1-844-810-1507 or info@EMCFWsettlement.com.

Where can I find more information about the settlement?

For more information about the Edna Mahan Correctional Facility for Women Class Action Settlement, you can visit the official settlement website at www.EMCFWsettlement.com.

Common mistakes

Filling out the Class Action Claim form can be a straightforward process, but many people make common mistakes that can jeopardize their claims. Understanding these pitfalls can help ensure that you complete the form correctly and secure your rightful compensation.

One frequent error is failing to complete all required sections of the Claim Form. Each section plays a critical role in verifying your eligibility for compensation. When any part is left blank or incomplete, it can lead to delays or even rejection of your claim. Take care to provide all requested personal information, tier selection, and certifications to make sure your submission is valid.

Another mistake individuals often make is not signing or dating the Claim Form before submission. The certification section explicitly requires your signature, verifying that the information you provided is true to the best of your knowledge. Without it, the form may be deemed invalid, causing you to miss out on compensation. Always remember to review your form one last time to ensure that it is signed and dated.

Some claimants overlook the importance of keeping copies of their completed Claim Form and related documentation. It’s essential to maintain your own records for reference in case any follow-up communication is needed. This way, you have proof of what you submitted, should any discrepancies arise later in the process.

Finally, be mindful of mailing deadlines. The deadline for postmarking your Claim Form is often specified, and missing it could mean forfeiting any compensation. It is crucial to allow enough time for mailing and, if needed, to consider using a service that provides tracking to confirm delivery before the final date.

By avoiding these common mistakes, you can navigate the Class Action Claim form process more smoothly and improve your chances of receiving the compensation you deserve.

Documents used along the form

When participating in a class action lawsuit, several documents accompany the Class Action Claim form to ensure a smooth process. Understanding these forms can empower claimants to effectively navigate the intricacies of their claim. Here's a brief overview of documents that may be needed along with the Claim form.

  • Notice of Class Action Settlement: This document informs individuals about the class action lawsuit, including key details about the settlement, eligibility, and important deadlines. It’s essential for understanding your rights and options regarding participation in the settlement.
  • Opt-Out Form: If a claimant prefers not to participate in the settlement, this form allows them to opt out. Choosing to opt out means they relinquish any right to compensation from the settlement but may pursue their own legal action.
  • Affidavit or Certification for Tier 2 and Tier 3 Claims: Required for claimants seeking higher compensation based on experiences of sexual harassment or abuse, this document serves to substantiate their claims. It must detail the incidents claimed and may require supporting evidence.
  • Fairness Hearing Notice: This document provides information about an upcoming hearing where the court will assess the fairness of the settlement. It invites class members to attend, voice their opinions, or raise objections to the proposed settlement.
  • Settlement Agreement: This legal document outlines the terms of the settlement between the parties involved. It includes the obligations of the defendant and details on how claimants will receive compensation. Understanding this agreement is key to fully grasping the terms of the settlement.

Being familiar with these documents can make a significant difference in how effectively individuals can advocate for their rights. When combined with the Class Action Claim form, they provide a comprehensive framework for realizing potential compensation and securing fair treatment within the judicial system.

Similar forms

  • Claim Form: Similar to the Class Action Claim form, an individual Claim Form is used to assert a personal claim for compensation or benefits. Like the Class Action Claim form, the individual Claim Form requires personal information and details regarding the claim being made.

  • Settlement Agreement: This document outlines the terms and conditions of a settlement between parties. Much like the Class Action Claim form, it provides the necessary details to claim participation in the agreement and the compensation outlined.

  • Release of Claims Form: This form is submitted to release the defendant from any further claims. It is similar in structure to the Class Action Claim form, typically requiring the signer's consent and confirmation that they understand the implications of releasing claims.

  • Affidavit: An affidavit is a written statement confirmed by oath or affirmation. Like the Class Action claim form, an affidavit may be required to support specific claims, particularly regarding details of incidents experienced while incarcerated.

  • Certification of Service: This document verifies that a legal document has been properly delivered to a party. In a way similar to the Class Action Claim form, it provides necessary information to confirm participation and includes signatures and dates.

  • Notice of Claim: This notice informs the concerned parties that a claim has been filed. Comparable to the Class Action Claim form, it serves as a formal declaration and includes personal identification details along with specifics about the claim.

  • Proof of Claim: Applied typically in bankruptcy cases or settlements, this document is used to declare a claimant's right to a portion of a settlement. It shares similarities with the Class Action Claim form, as it requires similar personal information and explanation of the claim.

  • Conditional Release Form: This form allows one party to release another from liability under specific conditions. It is related to the Class Action Claim form in that it seeks to outline the terms that relate to the release of claims and obligations.

  • Claim Review Form: Used during the process of reviewing claims, this form collects additional information that may be needed following the submission of a Claim. Like the Class Action Claim form, it requires thorough completion and relevant details to ensure a streamlined review process.

  • Hearing Request Form: If claimants wish to appeal or contest a decision regarding their claims, they may submit this form. In this way, it serves as a procedural document similar to the Class Action Claim form, requesting consideration and response from the responsible parties.

Dos and Don'ts

When completing the Class Action Claim form, it's important to follow certain guidelines to ensure your submission is successful. Here are some things you should and shouldn't do:

  • Do complete all sections of the Claim Form thoroughly.
  • Do sign and date your Claim Form in Section IV.
  • Do keep copies of your completed Claim Form and any supporting documents for your records.
  • Do mail your completed Claim Form to the address provided at the top of the form.
  • Don’t wait until the last minute to submit your form; make sure it is postmarked by the deadline.
  • Don’t forget to notify the Settlement Administrator of any changes to your contact information after submission.

Following these tips can help ensure that your claim is processed smoothly and that you receive any compensation you may be entitled to.

Misconceptions

Understanding the Class Action Claim Form can be challenging. Here are some common misconceptions people may have:

  • A claim form is optional. Many believe that submitting a claim form isn’t necessary. However, failure to complete and return the form by the deadline will result in forfeiting any compensation.
  • All tiers of compensation are the same. Each tier offers different compensation amounts and requirements. For example, Tier 1 offers $1,000 without additional documentation, while Tiers 2 and 3 have stricter conditions and higher potential payouts.
  • No documentation is needed for Tiers 2 and 3. This is not true. Tier 2 requires a separate affidavit describing the harassment, while Tier 3 demands both an affidavit and corroborating documents about the abuse experienced.
  • Submitting a claim guarantees payment. Just because you submit a claim doesn’t mean you will receive compensation. Claims will be reviewed, and payouts depend on the approval of each claim based on the evidence provided.
  • You cannot change your contact information after submission. Some think that once the claim form is sent, they cannot update their contact details. In reality, you can inform the Settlement Administrator of any changes after submission.
  • Help is not available for completing the form. Many assume they must go through the process alone. However, there is assistance available for those requesting a hearing, as legal clinics can help prepare necessary documents.

Key takeaways

Filling out and utilizing the Class Action Claim form requires careful attention to detail. Here are some essential takeaways to ensure you complete the process smoothly:

  • Deadline Awareness: Your claim form must be completed and postmarked on or before October 29, 2021. Late submissions will forfeit any compensation.
  • Personal Information: Accurately provide your personal details, including name and contact information. Ensure you include how you are identified while incarcerated.
  • Tier Selection: Choose the appropriate tier for compensation that reflects your circumstances. Each tier has specific requirements and compensation amounts.
  • Documentation Requirements: Tiers may need additional affidavits or corroborating documents to support your claims. Pay close attention to these requirements to maximize your compensation.
  • Hearing Requests: If applicable, indicate whether you want a hearing for your claim. This option is essential for more serious claims under specific tiers.
  • Pro Bono Assistance: If you are in Tiers 2 or 3, consider requesting assistance from a law school clinic. Their help may provide valuable support throughout the process.
  • Certification: Ensure you certify that all information is accurate. Providing false information can lead to penalties.
  • Stay Informed: Keep in touch with the Settlement Administrator regarding any changes to your contact information. For questions, you can reach out by phone or email.

By following these guidelines, you can enhance your chances of a successful claim and ensure you meet all necessary requirements.

Browse Other Templates

Eb Tariff Change Letter Format in Tamil - It is divided into four main forms, each serving a specific purpose related to name transfer requests.

Broker Partnership Application,Mortgage Broker Network Enrollment,UWM Affiliate Registration,Wholesale Mortgage Broker Signup,UWM Collaboration Form,Broker Integration Application,Wholesale Lending Partnership Form,Mortgage Broker Support Document,UW - Send your completed package to the UWM corporate office.

Printable Power of Attorney for Child - Legal requirements for traveling with a minor can be fulfilled with this form.